Roenikya L. Phillips, DMD, MPH

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

PEDO-535-17 Issued in MS

Practice address

303 Hospital Dr
Cleveland, MS 38732

Phone

(662) 843-5011

NPI assigned

Jul 28, 2011

Last updated

Feb 5, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dge6472@yourcarecommunity.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Little Smile Company

  dba Little Smile Co. Pediatric Dentistry & Orthodontics

  • Pediatric Dentistry
  • Cleveland, MS
  • NPI 1366916892
  NPD Authorized official
• Children's Dental Clinic

  • Pediatric Dentistry
  • Cleveland, MS
  • NPI 1568755106
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549324800000",
    "number": "1407134109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 S CHRISMAN AVE # 730",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387323316",
            "telephone_number": "662-801-6863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 HOSPITAL DR",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "38732",
            "telephone_number": "662-843-5011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4266 Highway 8",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "MS",
            "postal_code": "387328503",
            "country_code": "US",
            "telephone_number": "662-843-0001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "ROENIKYA",
        "middle_name": "L.",
        "name_prefix": "Ms.",
        "credential": "DMD, MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-28",
        "last_updated": "2019-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "3607-11",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MS",
            "license": "PEDO-535-17",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04753806",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• PHC-Cleveland Inc. (Bolivar Medical Center Long Term Care Facility)
• PHC-Cleveland LLC (Bolivar Medical Center)
• PHC-Cleveland LLC (Bolivar Medical Center)
• PHC-Cleveland LLC (Bolivar Medical Center)
• PHC-Cleveland, Inc. (Bolivar Medical Center Skilled Nursing Unit)
• Michael E Portner, MD
• Susan Prather, CFNP
• Stevenson Prescott
• Mary Elizabeth Prestage, M.A.
• Julie Manning Price, OT

• Pediatric Dentistry in Cleveland, MS
• Providers in Cleveland, MS by specialty
• Pediatric Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.